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This study aimed to investigate the relationship between cerebral small vessel disease (CSVD) and orthostatic hypotension (OH) using self-measured blood pressure at home in community-dwelling older subjects. Between May 2016 and October 2018, 663 community-dwelling adults aged ≥60 years were enrolled in Shandong, China. CSVD, including white matter hyperintensities (WMHs), lacunes, enlarged Virchow-Robin spaces (EVRS) and microbleeds, was assessed using brain magnetic resonance imaging. After receiving appropriate training, the subjects participated in "home-measured (H)OH" by themselves for three consecutive days. Participants were classified into no-HOH, 1 HOH, and ≥2 HOH episode groups according to the presence of HOH episodes. The WMH volume, WMH-to-total intracranial volume (TIV) ratio, total numbers of lacunes and EVRS, and prevalence of Fazekas scale score ≥2, lacunes, and EVRS were elevated in the 1 and ≥2 HOH episode groups compared with the no-HOH episode group (P < 0.05). The prevalence and total number of microbleeds were significantly higher in the ≥2 HOH episodes group than in the no-HOH and 1 HOH episode groups (P < 0.05). HOH episodes were significantly associated with WMH volume, WMH-to-TIV ratio, and the total numbers of lacunes, EVRS, and microbleeds after adjustment for confounders (P < 0.05). The risks of Fazekas scale score ≥2, lacunes, EVRS, and microbleeds were 2.123-, 1.893-, 2.162-, and 1.656-fold higher in the 1 HOH episode group and 4.910-, 5.359-, 3.048-, and 2.418-fold higher in the ≥2 HOH episodes group, respectively, than those in the no-HOH group. The presence of HOH episodes was an independent risk factor for CSVD in the community-based older population.

Background: Although it is accepted that the etiology of cerebral small vessel disease (CSVD) is associated with cardiovascular risk factors, the association between CSVD and the circadian rhythm of blood pressure (BP) is unclear. We aimed to determine if such an association existed in the elderly population., Method: White matter hyperintensities (WMHs), lacunes, microbleeds, nocturnal dipping pattern (NDP), and morning surge in systolic blood pressure (SBP) were assessed in 2,091 participants ≥60 years of age., Results: During an average of 63 months of follow-up, WMH and the WMH-to-intracranial volume ratio were significantly increased in extreme dippers, nondippers, and reverse dippers than those in dippers (p < .001). For new-incident Fazekas scale ≥2, the hazard ratios were 1.77 (95% confidence interval [CI], 1.09-2.86) for extreme dippers, 2.20 (95% CI, 1.48-3.28) for nondippers, and 2.43 (95% CI, 1.59-3.70) for reverse dippers compared with dippers, and 1.04 (95% CI, 0.81-1.35) for higher morning surge compared with lower morning surge. Nondippers and reverse dippers were associated with higher risks of new-incident lacunes and microbleeds than dippers (p < .05). Higher morning surge was associated with a higher risk of new-incident microbleeds than lower morning surge (p < .05)., Conclusion: NDPs in SBP played an important role in CSVD, and the morning surge in SBP was associated with cerebral microbleeds in community-based elderly population beyond the average SBP level., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: To explore how central hemodynamics respond to dietary sodium and potassium interventions, and whether the responses are associated with metabolic traits., Methods: We conducted a dietary intervention study including a 7-day low-sodium (51.3 mmol sodium/day) intervention, a 7-day high-sodium (307.8 mmol sodium/day) intervention, and a 7-day high-sodium with potassium supplementation (60.0 mmol potassium/day) intervention among 99 northern Chinese subjects aged 18-60 years. Five metabolic traits included abdominal obesity, high triglycerides, low HDL cholesterol, raised blood pressure (BP), and high glucose. Central hemodynamics were measured at baseline and during each intervention., Results: Central systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and augmentation index (AIx@75) significantly decreased during low-sodium intervention, increased during high-sodium intervention, and then decreased during potassium supplementation. We observed potential linear trends toward significance of central SBP and PP responses to low-sodium intervention, and significant linear trends of responses to high-sodium intervention as the number of metabolic traits grows. For example, among participants with 0 or 1, 2 or 3, and 4 or 5 metabolic traits, central SBP responses to high-sodium intervention were 8.8 [95% confidence interval (5.8, 11.8)], 9.3 (7.1, 11.6), and 14.0 (11.6, 16.3) mmHg, respectively (P for trend = 0.009). Significant linear trends of central SBP and DBP responses to potassium supplementation were also observed., Conclusions: Central BP and AIx@75 were lowered by sodium reduction and potassium supplementation, and elevated by sodium-loading. The responses of central BP were pronounced among individuals with metabolic traits clustering., Clinical Trials Registration: Trial Number NCT00721721 (The current study is registered on ClinicalTrials.gov; https://clinicaltrials.gov).

To investigate the effects of variability in self-measured systolic blood pressure at home on the progression of cognitive impairment and white matter lesions in the oldest old. Between April 2009 and October 2009, 248 oldest old aged 80 years or older were eligibly enrolled from geriatric practices and community-dwelling areas of Shandong, China. Self-measured blood pressure at home (HBP) was measured for 7 consecutive days at the baseline, and the Mini-Mental State Examination (MMSE) score and brain white matter hyperintensities (WMH) were assessed at the baseline and during the final follow-up visit. Variability in systolic HBP was evaluated using coefficient of variation (CV) in serial daily systolic HBP measurements of the last 6 consecutive days. After an average of 2.3 years of follow-up visits, 232 oldest old were included in and 16 were excluded from the analysis. The MMSE score declined -4.76 (interquartile ranges: -10.71, -0.83) %, the periventricular WMH, deep WMH, total WMH and WMH fraction increased 16.46 (s.d.: 6.72)%, 10.05 (s.d.: 6.40)%, 14.69 (s.d.: 6.07)% and 15.95 (s.d.: 6.32)%, respectively, in the total oldest old. A declined percentage of the MMSE score and increased percentages of the periventricular WMH, deep WMH, total WMH and WMH fraction in the high group divided by tertile of the CV of the systolic HBP at baseline were greater than those in the low group (P<0.05). The significant differences were retained after adjusting for covariates, including the MMSE score, periventricular WMH, deep WMH and WMH fraction at the baseline (P<0.05). Excessive variability in self-measured systolic HBP exacerbates the progression of cognitive impairment and brain white matter lesions in the oldest old.

High-normal blood pressure is considered a precursor of stage 1 hypertension that is associated with metabolic disorders. This study aims to investigate whether the pharmacologic treatment of high-normal blood pressure affects metabolism, especially in abdominally obese individuals, and the pharmacoeconomics of two antihypertensive agents, telmisartan and indapamide. Subjects with high-normal blood pressure were randomly assigned to receive telmisartan, indapamide or placebo for 3 years. All the subjects were instructed to modify their lifestyle to reduce blood pressure throughout the study. A total of 221 subjects were randomly assigned to telmisartan, 213 to indapamide and 230 to placebo. After the 3-year intervention, blood pressure was lower in the telmisartan and indapamide groups (P<0.05), FPG in the telmisartan group was lower during the first 2 years (P<0.05) and no characteristic differences were found in those with abdominal obesity among the three groups (P>0.05). The percentage of subjects with metabolic syndrome was significantly decreased in the telmisartan and indapamide groups (P<0.05), but was only significantly decreased in the telmisartan group for subjects with abdominal obesity (P<0.05). The acquisition cost for telmisartan was ~1.86 times higher than for indapamide for a similar antihypertensive effect. The intervention for high-normal blood pressure with telmisartan and indapamide appeared to be feasible and reduced the risk of metabolic syndrome. Telmisartan was more effective, whereas indapamide had better pharmacoeconomic benefits.

Background: Visit-to-visit variability in blood pressure (BP) was demonstrated to correlate with cardiovascular events independent of mean BP. The goal of the present study was to investigate the correlation of visit-to-visit BP variability with artery stiffness and myocardial perfusion in on-treated hypertensive patients., Methods: BP was measured in 271 hypertensive patients at every visit over the course of the antihypertensive treatment, and the standard deviation (SD), coefficient of variation (CV), maximum, and minimum in serial BP were calculated. Non-invasive pulse wave analysis was performed in all patients., Results: Compared with baseline, carotid-femoral pulse wave velocity (cfPWV), aortic augmentation index (Aix) and Aix adjusted to a "standard heart rate" of 75 beats/min (Aix@HR75) were markedly declined, and sub-endocardial viability ratio (SEVR) was obviously increased in each group (p < 0.001). The changes of cfPWV, SEVR, Aix and Aix@HR75 in patients with lower SD of systolic blood pressure (SBP) were significantly greater than those in patients with higher SD of SBP. And the changes were statistically correlated with both SD and CV of serial SBP during follow-up, even after adjusted for mean SBP and mean diastolic blood pressure (DBP)., Conclusion: Visit-to-visit SBP variability is independently correlated with changes of artery stiffness and myocardial perfusion in on-treated hypertensive patients.

Objectives: This study was designed to explore the appropriate blood pressure (BP) target required to reduce cognitive decline and brain white matter lesions (WMLs) in elderly hypertensive patients., Methods: Elderly patients (n = 294, ≥80 years of age) being treated for hypertension were enrolled in a longitudinal study examining cognitive impairment after an initial assessment and a period of 4 years. All patients underwent neurological and cognitive assessment, laboratory examination, and magnetic resonance imaging of the brain., Results: The 4-year follow-up examination revealed that body mass index, alcohol consumption, systolic blood pressure (SBP), diastolic blood pressure, and Mini-Mental State Examination (MMSE) all showed a significant decline, whereas fasting plasma glucose, white matter hyperintensities (WMH) volume, and the WMH/total intracranial volume (TIV) ratio were significantly increased when compared with baseline observations. Interestingly, the decline in MMSE, as well as the increment of WMH and WMH/TIV ratio was smaller in patients with SBP ranging from 140 to 160 mm Hg than in those whose SBP was lower than 140 mm Hg or higher than 160 mm Hg (P < .05). Furthermore, we observed that a 15 to 35 mm Hg targeted lowering of SBP in the elderly patients was more beneficial to our cognitive analysis than treatments that achieved less than 15 mm Hg or greater than 35 mm Hg (P < .05)., Conclusions: In elderly hypertensive patients, there exists a beneficial target for SBP lowering beyond which treatment may not be beneficial for improving or delaying the progression of cognitive impairment and WMLs., (Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate variability in self-measured home blood pressure (HBP) and its effects on carotid artery atherosclerosis and endothelial function in normotensive and mild-moderate hypertensive individuals., Materials and Methods: This is a cross-sectional study. HBP monitoring over 7 consecutive days, carotid artery ultrasound, and brachial artery flow-mediated dilation (FMD) were performed in 314 normotensive, prehypertensive, and mild-moderate hypertensive volunteers. Variability in HBP was assessed by the SDs of the daily BP average of the last 6 consecutive days. The plasma endothelin-1 (ET-1) level was tested using an enzyme-linked immunosorbent assay., Results: The tendency of SD of systolic HBP increased significantly from the normotension to the moderate hypertension group. SD of systolic HBP was significantly correlated with carotid intima-media thickness (IMT) (r=0.569, P<0.001), stiffness parameter β (r=0.447, P<0.001), FMD (r=-0.636, P<0.001), and ET-1 (r=0.649, P<0.001). SD of diastolic HBP was also correlated with carotid IMT, stiffness parameter β, FMD, and ET-1, but the strength of the correlation was weaker than SD of systolic HBP (all P<0.001). After adjustment of all covariants, SD of systolic HBP was always significantly associated with carotid IMT, stiffness parameter β, FMD, and ET-1., Conclusion: Day-by-day variability in HBP increased with increasing BP level. This was significantly associated with carotid artery atherosclerosis and endothelial function in normotensive and mild-moderate hypertensive individuals. Day-by-day variability in HBP may serve as an important prognostic factor for atherosclerosis and endothelial dysfunction.